A randomized controlled trial comparing the frequency of acute reactions to plasma-removed platelets and prestorage WBC-reduced platelets

Authors

  • Nancy M. Heddle,

    1. From the Departments of Pathology and Molecular Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton;
    2. Departments of Pathology and Medicine, University of Toronto, Toronto, Ontario;
    3. Canadian Blood Services (Hamilton, Toronto and Ottawa), Canada.
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  • Morris A. Blajchman,

    1. From the Departments of Pathology and Molecular Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton;
    2. Departments of Pathology and Medicine, University of Toronto, Toronto, Ontario;
    3. Canadian Blood Services (Hamilton, Toronto and Ottawa), Canada.
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  • Ralph M. Meyer,

    1. From the Departments of Pathology and Molecular Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton;
    2. Departments of Pathology and Medicine, University of Toronto, Toronto, Ontario;
    3. Canadian Blood Services (Hamilton, Toronto and Ottawa), Canada.
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  • Jeff H. Lipton,

    1. From the Departments of Pathology and Molecular Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton;
    2. Departments of Pathology and Medicine, University of Toronto, Toronto, Ontario;
    3. Canadian Blood Services (Hamilton, Toronto and Ottawa), Canada.
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  • Irwin R. Walker,

    1. From the Departments of Pathology and Molecular Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton;
    2. Departments of Pathology and Medicine, University of Toronto, Toronto, Ontario;
    3. Canadian Blood Services (Hamilton, Toronto and Ottawa), Canada.
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  • Graham D. Sher,

    1. From the Departments of Pathology and Molecular Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton;
    2. Departments of Pathology and Medicine, University of Toronto, Toronto, Ontario;
    3. Canadian Blood Services (Hamilton, Toronto and Ottawa), Canada.
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  • Lorrie A. Constantini,

    1. From the Departments of Pathology and Molecular Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton;
    2. Departments of Pathology and Medicine, University of Toronto, Toronto, Ontario;
    3. Canadian Blood Services (Hamilton, Toronto and Ottawa), Canada.
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  • Bruce Patterson,

    1. From the Departments of Pathology and Molecular Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton;
    2. Departments of Pathology and Medicine, University of Toronto, Toronto, Ontario;
    3. Canadian Blood Services (Hamilton, Toronto and Ottawa), Canada.
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  • Robin S. Roberts,

    1. From the Departments of Pathology and Molecular Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton;
    2. Departments of Pathology and Medicine, University of Toronto, Toronto, Ontario;
    3. Canadian Blood Services (Hamilton, Toronto and Ottawa), Canada.
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  • Kevin E. Thorpe,

    1. From the Departments of Pathology and Molecular Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton;
    2. Departments of Pathology and Medicine, University of Toronto, Toronto, Ontario;
    3. Canadian Blood Services (Hamilton, Toronto and Ottawa), Canada.
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  • Mark N. Levine

    1. From the Departments of Pathology and Molecular Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton;
    2. Departments of Pathology and Medicine, University of Toronto, Toronto, Ontario;
    3. Canadian Blood Services (Hamilton, Toronto and Ottawa), Canada.
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  • Supported by grants from Bayer/Canadian Blood Services Research Fund, Gambro BCT, The Canadian Institutes for Health Research, and Canadian Blood Services.

Address reprint requests to: Nancy M. Heddle, MSc, Room HSC-3N43, McMaster University, 1200 Main Street West, Hamilton, Ontario, Canada L8N 3Z5; e-mail: heddlen@mcmaster.ca.

Abstract

BACKGROUND: Removal of the plasma supernatant from platelets before transfusion is effective in preventing acute reactions to platelets caused by cytokines. Prestorage WBC reduction of platelets may be even more effective at preventing reactions as the WBCs are removed and WBC-derived cytokines do not accumulate in this component. This study evaluates the effectiveness of plasma removal and two methods of prestorage WBC reduction for preventing acute reactions to platelets.

STUDY DESIGN AND METHODS: Platelets given to adults with hematologic malignancies were randomly allocated to one of three types: plasma supernatant removed and a platelet storage solution added, whole blood-derived platelets that are prestorage WBC reduced by filtration before storage, and prestorage WBC-reduced apheresis platelets. Patients were monitored before, during, and after transfusion, and the severity of reactions was graded on a Likert scale.

RESULTS: A total of 129 patients from four centers were given 1190 platelet transfusions. The overall frequency of reactions was 13.6 percent (162 of 1190), 21.3 percent (36 of 169) for the plasma-removed platelets, 11.4 percent (59 of 517) for random donor WBC-reduced platelets, and 13.3 percent (67 of 504) for apheresis WBC-reduced platelets (p = 0.384). The overall frequency of severe reactions was 4.1 percent with plasma-removed platelets, 1.7 percent for whole blood-derived, prestorage WBC-reduced platelets, and 1.4 percent for prestorage WBC-reduced apheresis platelets.

CONCLUSION: The frequency of reactions to plasma-removed platelets and prestorage WBC-reduced platelets was not significantly different; however, the power of the study for this comparison was low. There was no difference in the frequency of reactions to the two types of prestorage WBC-reduced platelets. The frequency of severe reactions to prestorage WBC-reduced platelets is low, occurring in only 1 to 2 percent of transfusions.

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